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Internal Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

anterior vs posterior pituitary hormones?

A

made and stored in anterior. only stored in posterior (made in hypothalamus)

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2
Q

anterior pituitary hormones

A

GH, prolactin, TSH, LH, FSH, ACTH

-blood supply

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3
Q

posterior pituitary hormones

A

ADH, oxytocin

-neural supply

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4
Q

prolactin

A
  • needed for lactation

- usually inhibited, unless after childbirth

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5
Q

LH and FSH deficiency

A
  • dec libido
  • dec axillary, pubic, body hair
  • erectile dysfunction
  • no testosterone
  • no menstruation
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6
Q

Kallman syndrome

A

dec FSH & LH
dec GnRH
anosmia

=hypogonadal + dec smell

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7
Q

metyrapone

A

inhibits 11-beta hydroxylase –> dec cortisol

  • tests pituitary –> ACTH should rise; if not, the pituitary is damaged
  • insulin stimulation = another test (hypoglycemia should stimulate GH release)
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8
Q

central diabetes insipidus

A
  • brain damage (hypothalamus or posterior pituitary)

tx: vasopressin (desmopressin)

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9
Q

nephrogenic diabetes insipidus

A
  • kidney does not respond to ADH
  • hyperCa, hypoK, amyloid, myeloma, sickle cell disease
  • tx: hydrochlorothiazide, NSAIDs, amiloride
  • excessive thirst, polydipsia. volume depletion –> hyperNa –> neurologic symptoms
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10
Q

diabetes insupidus

A
  • low urine osmolality
  • low urine sodium
  • high serum osmolality
  • elevated urine volume
  • serum Na maintained with appropriate fluid intake
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11
Q

acromegaly

A
  • elevated GH
  • MEN 1 syndrome: parathyroid + pancreatic cancer

-inc hat, ring, shoe size –inc soft tissue size

  • carpal tunnel, OSA, body odor, teeth widening, deep voice, macroglossia, colonic polpys (–> cancer), arthralgia
  • HTN, hyperglycemia, hyperlipidemia
  • n: glucose suppresses GH
  • not in acromegaly

-tx: surgery, cabergoline (dopamine agonist), octreotide (somatostatin analog), lanreotide, pegvisomant, radiotherapy

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12
Q

hyperprolactinemia causes

A
  • pregnancy
  • cutting pituitary stalk ( =loss of neg feedback)
  • antipsychotics (dopamine antagonists)
  • TCAs
  • SSRIs
  • methyldopa
  • opiods
  • metaclopromide
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13
Q

hyperprolactinemia px

A
  • galactorrhea
  • amenorrhea
  • infertility
  • erectile dysfunction
  • dec libido
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14
Q

hyperprolactinemia dx & tx

A

-look at liver/ renal/ thyroid/ medication causes before MRI

  • dopamine agonists (cabergoline)
  • surgery (when not responding to meds)
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15
Q

TH

A

acts on Na/K ATPase

  • hypoTH –> fatigue, dec reflexed, cold intolerance
  • hyperTH –> anxiety, restlessness, hyperreflexia, heat intolerance, fever
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16
Q

hypoTH

A

causes:
thyroiditis (Hashimoto)
dietary deficiency of I
amiodarone

  • slow, except menstruation inc
  • dx: elevated TSH
  • tx: synthroid
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17
Q

Graves disease

A
  • hyperTH
  • eye proptosis, skin findings
  • TSH-R antibodies
  • elevated radioactive iodine uptake
  • steroids tx for proptosis
  • tx: radioactive iodine
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18
Q

subacute thyroiditis

A

painful thyroid

-tx: ASA

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19
Q

thyroid adenoma

A

high TSH and high T4

  • other forms of hyperTH have low TSH
  • tx: surgery removal
20
Q

thyroid storm tx

A

-propranolol: blocks target organ effects (B1 & B2), prevents conversion T4–>T3

  • methimazole
  • PTU: block TH production via thyroid peroxidase inhibition

-radioactive iodine (ablation); can result in hypoTH

21
Q

fine needle biopsy

A
  • only for normal-functioning thyroid
  • only means to dx cancer

-iodine uptake study for hyper-functioning thyroid

22
Q

medullary thyroid carcinoma

A
  • arises from C cells

- elevated calcitonin –> flushing, diarrhea, pruritis

23
Q

hyperCa causes

A
  • primary hyperPTH
  • cancer
  • vit D intoxication
  • sarcoidosis
  • thiazide diuretics (DCT)
  • hyperTH (inc osteoclast activity)
  • metastases to bone
  • MM
24
Q

hyperCa px

A 
confusion
constipation
bone lesions
kidney stones (nephrolithiasis)
DI --> volume loss (diuresis)
renal insufficiency (prerenal)
short QT syndrome
25
Q

hyperCa tx

A
  • massive saline hydration (NOT loop diuretics)
  • bisphosphonates: pamidronate, zolendronic acid
  • calcitonin: tachyphylaxis (wears off quickly); fast acting
  • prednisone for sarcoidosis
26
Q

hyperPTH causes & dx & tx

A
  • solitary adenoma
  • hyperplasia of all 4 glands
  • DEXA scan
  • image neck prior to surgery (look for edematous gland)

-surgical removal

27
Q

hyperPTH symptoms

A
  • osteoporosis
  • nephrolithiasis
  • muscle weakness
  • anorexia, n/v
  • abdominal pain
  • PUD (Ca stimulates gastrin)
  • high Ca, low phosphate
  • short QT
  • alk phos elevated
28
Q

hypoCa

A
  • twitchy, hyper excitable due to dec threshold for depolarization
  • -> easier to depolarize
  • Chvostek sign (facial nerve sensitivity)
  • Troussea sign (tetany)
  • seizure
  • prolonged QT –> v tachycardia
29
Q

hypothalmus –> pituitary –> adrenal glands

A

CRH –> ACTH –> cortisol –> free fatty acids & glucose released

30
Q

Cushing’s disease

A
  • pituitary overproduction ACTH (70%)

- ectopic production of ACTH –> carcinoid vs autonomous adrenal gland

31
Q

hypercortisolism px

A

=anti-insulin stress hormone

  • hyperglycemia
  • hyperlipidemia
  • hypoK, metabolic alkalosis
  • leukocytosis from demargination
  • fat redistribution (moon face, buffalo hump, truncal obesity, skin extremities)
  • skin striae, dec wound healing, think skin
  • osteoporosis
  • HTN
  • menstrual disorders
  • erectile dysfunction
  • polyuria (hyperglycemia –> osmotic diuresis)

-mixed mineral corticoid and androgen effects of cortisol

32
Q

hypercortisolism diagnostic tests

A
  • 24 hour urine cortisol
  • low dose dexamethasone suppression test
  • late night salivary cortisol
  • ACTH levels
  • high:pituitary OR ectopic source (high dose dexamethasone suppression test to differentiate)

-low:adrenal source (CT adrenals)

33
Q

Cushing’s tx

A

surgically remove from source

34
Q

pheochromocytoma dx

A

metanephrines in blood and urine

35
Q

hyperaldosteronism dx

A

renin and aldosterone levels

36
Q

Addison’s disease

A

=hypoadrenalism

-autoimmune, waterhouse-friedreich syndrome, TB, adrenoleukodystrophy, cancer

  • weak, fatigue, altered mental status, hyper pigmentation (from inc ACTH), hypotension, hypoglycemia, hyperK, metabolic acidosis
  • eosinophilia (you don’t have steroids, so you’re “allergic” to your adrenals)

-tx: hydrocortisone, fludrocortisone

37
Q

cosyntropin stimulation test

A

cortisol is supposed to rise

  • low cortisol, high ACTH, low aldosterone = primary adrenal insufficiency
  • low cortisol, low ACTH, inc aldosterone = adrenal insufficiency secondary to pituitary insufficiency
38
Q

pheochromotcytoma

A 
episodic HTN
headache
sweating
palpitations
tremor

plasma catecholamines
24 hour urine metanephrines and catecholamines

biochemical testing –> then imaging with MRI or CT

MIBG scan to find extra-adrenal pheochromocytoma

tx: phenoxybenzamine (IV alpha blocker), propranolol (beta blocker), CCB, laproscopic removal

39
Q

DB

A

polyuria, polyphagia, polydipsia

immunocompromised

2 fasting gluc > 125
1 gluc > 200

oral glucose testing – fast

Hg A1C > 6.5%

40
Q

DB type 1

A
  • insulin DEFICIENCY
  • autoimmune
  • childhood
  • DKA
41
Q

DB type 2

A
  • insulin RESISTANCE
  • acquired
  • adult/ some kids
  • obesity related
42
Q

DB tx

A
  • diet/exercise
  • metformin (blocks gluconeogenesis),
  • sulfonylureas (inc insulin release, weight gain)
  • dipeptidyl peptidase inhibitors (sita/saxagliptans –inc insulin, dec glucagon via incretins)
  • glitazones (risk in CHF)
  • nateglinide/ repaglinide (weight gain, inc insulin release)
  • acarbose, miglitol = alpha glucosidase inhibitors (diarrhea, flatus, abdominal pain) 3x/day
  • amylin analog (pramlintide)
  • insulin
  • incretins usually have short half life
43
Q

DKA

A
  • inc fatty acid breakdown
  • px: hyperventilation, altered mental status, metabolic acidosis, increased anion gap, hyperK (in blood not body), ketones
  • tx: large volume saline, insulin, replace K, correct underlying cause (infections, noncompliance with meds)
  • serum bicarb indicates severity
44
Q

DB health maintenance

A
  • pneumococcal vaccine
  • yearly eye exam
  • statins to get LDL < 100
  • ACEI or ARB for BP < 130/80
  • ACEI or ARB for microalbuminuria
  • foot exam for neuropathy or ulcers
45
Q

gastroparesis secondary to DB

A
  • immobility of bowels
  • bloating, constipation
  • early satiety, vomiting
  • abdominal discomfort

-tx: metoclopramide (inc gastric mobility) OR erythromycin (SE GI hypermotility; tiny dose)

Internal Medicine (9 decks)

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